Study: Many Women at High Risk for Mammography Screening Failure Do Not Receive Supplemental Screening

Many women who are at high risk for mammography screening failure do not receive supplemental ultrasound screening, according to the results of a study published in Cancer.

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Investigators found that ultrasound screening was targeted toward women with dense breasts, but a modest proportion were at high risk of mammography screening failure.

Currently, there is no consensus guidelines for supplemental breast cancer screening, which includes an ultrasound, but there are criteria for women who are considered at high risk of mammography screening failure.

Investigators of the study aimed to determine what the mammography screening failure risk was in women undergoing supplemental ultrasound screening and those who only had mammography screening.

There was a total of 38,166 ultrasounds and 825,360 mammograms without supplemental screening included from 3 Breast Cancer Surveillance Consortium (BCSC) registries. The BCSC registries included Metro Chicago, San Francisco, and Vermont. The data were from 2014 to 2020.

Approximately 75% of the ultrasound screenings were the individual’s first and 63% of ultrasounds occurred within 9 months after a mammogram, according to the results of the study.

Investigators used the BCSC prediction models to evaluate the risk of interval invasive cancer and advanced cancer. The high interval invasive breast cancer was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk of 2.5% or greater, or extremely dense breasts with a BCSC 5-year breast cancer risk of 1.67% or greater.

Intermediate and high advanced cancer risk was defined as a BCSC 6-year advanced breast cancer risk of 0.38% or greater.

A total of 95.3% of the ultrasounds were for women who had heterogeneously or extremely dense breasts compared with 41.8% of women who were only screamed with mammograms.

Additionally, 21.7% of women who had ultrasound screenings had a first-degree family history of breast cancer, 24.3% had a prior benign breast disease diagnosis, and 43.7% of women were overweight or obese.

Investigators found that among women with dense breasts, high interval invasive breast cancer risk was found in 23.7% of ultrasounds compared to 18.5% of those screened with mammograms without supplemental imaging. Additionally, they found that intermediate and high advanced cancer risk was found in approximately 32% of ultrasound screenings compared to 30.5% of mammogram screenings alone.

When compared to mammography, ultrasound screening was more likely to occur in women aged younger than 50 years, those who were premenopausal, had dense breasts, and normal body mass index (BMI). Investigators also said that there were small differences in race, ethnicity, family history of breast cancer, and individual history of benign breast disease.

However, investigators found that when the analysis was restricted to women with dense breasts, ultrasound screening was more likely for women who were white, and slightly more likely for those who were aged younger than 50 years, premenopausal, had extremely dense breasts, a family history of breast cancer, and a history of benign breast disease. BMI was similar across the groups, according to the results.

Investigators determined that the distributions of breast cancer risk, interval invasive breast cancer risk, and advanced cancer risk varied among those who received ultrasound screening. They called for further public awareness of other breast cancer risk factors, which could help identify more women who are at high risk of mammography screening failures.

Reference

Sprague BL, Ichikawa L, Eavey J, Lowry KP, et al. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer. 2023;10.1002/cncr.34768. doi:10.1002/cncr.34768